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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I I I I I I I I l <br /> Page I of 1 nefer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 No.774116 FI -1 _' 1 <br /> L- ❑ <br /> Date Work Began 11/7/00 Ended11/10/00 LATITUDE LONGITUDE <br /> Local Permit Agency Public Health Services I I I I I I I I I I I I I <br /> Permit No. 24485 Permit Date 11/6/00 1 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL _HORIZONTAL ANGLE _(SPECIFY) Name Fredriks Nursery__ _ <br /> DRILLING ROTARY _ <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 23223 S.Austin Rd. _ <br /> SURFACE DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0; 6;Soil Address 23245 S.AustinN�ggdLL LOCATIO ' <br /> _ 12:Sand — City Ripon CA <br /> 12 40'Clay&Sand Streaks - County San Joaquin <br /> 40 46 Sand _ APN Book Page Parcel <br /> 46, 84 Clay - Township --Range ---Section <br /> 84 90,Sand -- - - --- <br /> ----.- -- - -- Latitude ____ <br /> 90 1_40 r Clay DEG. MIN. SEC. DEG. _MIN <br /> 140, 144 Sand ——— - LOCATION SKETCH ACTIVITY (� <br /> 144� _ 150;Clay -- -- NORTH NEW WELL <br /> 150 163 Coarse Sand MODIFICATIIONfREPAIR <br /> Deepen <br /> 163' _ 190 Clay Other Specify) <br /> 190 196 Coarse Sand <br /> DESTROY(Describe <br /> 196 235 Clay Procedures and Materials <br /> ads N <br /> T Under"GEOLOGIC LOG" w <br /> — I PLANNED USES(,-,) c <br /> WATER SUPPLY <br /> to Domestic— Public -t+, <br /> . ¢ Irrigation _ Industrial (n <br /> i ul MONITORING— "1 <br /> TEST WELL <br /> ATHODIC PROTECTION_ ` <br /> HEAT EXCHANGE— <br /> DIRECT PUSH _ <br /> -- INJECTION <br /> - -- VAPOR EXTRACTION — <br /> _ _ SPARGING <br /> SOUTH -— REMEDIATION-_ <br /> -- —- lihanute or Describe Distance of Well from Roads. Buildings. <br /> = - <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFnecessary. AC = <br /> -- - -- <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER- (Ft.)BELOW SURFACE <br /> DEPTH OF STAT LC <br /> — - WATER LEVEL Z6 _ (Ft.)&DATE MEASURED -11/10/00 <br /> - - --- -- — ESTIMATED YIELD ' (GPM)8 TEST TYPE _ <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH—(Hrs.)TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL205 (Feet) May not be representative o a ivell's long-term yield. <br /> DEPTH BORE- <br /> CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYZE �> � I FROM SURFACE TYpE <br /> - -- DIA. Y w o a MATERIAL! INTERNAL GAUGE SLOT SIZE CE- BEN <br /> Ft to FI. (Inches) g W 'pt' a. GRADE DIAMETER OR WALL I IF ANY MENT)TONITt FILL FILTER PACK <br /> m ti Q LL (Inches) THICKNESS (Inches) Ft. to FL (TYPE/SIZE) <br /> 0' 185 14 ✓ PLASTIC 1 81 160_ 160 . 0 108 <br /> 185 205 - ✓ 108 205 GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC. <br /> Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> Soil/Water Chemical Analysis 119 Albers Rd. _ _ Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS, Signed 11/15100 _ _ 668622 <br /> LL DRILLER/AUTHGRIZEO REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV 11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />